hemorrhagic pulmonary infarction ICD-10: I26
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Mann, 68 J., Linksherzinsuffizienz bei Aortenstenose, plötzlich
stechender Thoraxschmerz, Pleurareiben; verstirbt akut nach schwerer
Dyspnoe und Hämoptyse. Autopsiepräparat
- Subpleuraler, keilförmiger, nicht ganz frischer hämorrhagischer
Lungeninfarkt mit kokardenartiger Schichtung
- Im Zentrum Nekrose: Alveolarzellen teilweise bereits abgeräumt;
Interalveolarsepten fehlen
- Gegen Peripherie leukozytäre Demarkation, reaktive
Hyperämie
- Perifokale lymphohistiozytäre Reaktion
und beginnende Organisation
- Aeltere fibrinöse Pleuritis
- Am Fuss des keilförmigen, scharf begrenzten Infarktes nicht
ganz frischer embolischer Verschluss
mit beginnender Organisation
- Lungengewebe ausserhalb Infarkt, sog. "fibrosierende Alveolitis"
(="Schock-lunge") = ischämische Läsion durch Perfusionsstörung,
bestehend aus hyalinen, kapillären Mikrothromben und hyalinen
Lungenmembranen
68-year-old male suffered from congestive heart disease due to aortic stenosis. He experienced a
sudden stabbing chest pain. Examination of the lungs revealed a pleural friction rub. After an episode of acute severe dyspnea
and hemoptysis, the patient passed away (specimen from autopsy).
- A wedge-shaped subpleural hemorrhagic (red) infarct is present.
- Within the hemorrhage, the outlines of the alveoli are still visible. However, the tissue has undergone coagulative necrosis and
viable cells are lacking. Some of the debris has been already cleared.
- A dense infiltrate of neutrophilic granulocytes is observed within the infracted area, indicating presence of infarct pneumonia.
- A rim of fibrous tissue, capillary proliferations and inflammatory cells surround the infracted area
(beginnende Organisation, organization) and reactive hyperemia
(reaktive Hyperämie).
- Close to the apex of the infarct, a partially occluded vessel is observed. The occluding thrombembolus is partly organized
(embolischer Verschluss). In addition,
venules show medial thickening and intimal fibrosis (arterialization) because of chronic congestion.
- The pleura adjacent to an infarct is often covered by a fibrinous exudate (not present in the slide displayed).